Healthcare Provider Details

I. General information

NPI: 1093123853
Provider Name (Legal Business Name): LINDA BEAUREGARD LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2014
Last Update Date: 07/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 1ST ST NE 9TH FLOOR
WASHINGTON DC
20002-3361
US

IV. Provider business mailing address

1200 1ST ST NE 9TH FLOOR
WASHINGTON DC
20002-3361
US

V. Phone/Fax

Practice location:
  • Phone: 202-442-4800
  • Fax: 202-442-5026
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberLC50080047
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: